P - 80642� REQUEST FOR ELECTRICAL INSPECTION -°°� _
7 O�� 3 5 9 � Minnesota State Board of Electricity
� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
Phone(612)642-0800
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Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ra�ge Elec. Heat Temp. Service
"X" above the work covered by this requesi. Enter remarks in this space and on the back of the rihite copy only.
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Calculate inspection Fee - This Inspeciion Requesi will not be accepted without the co�c�ee: �"���`
Other Fee # Servic trance S' Fee # CircuitsJFeeders Fee ,
Mobile Home Park Stall 200 mps to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s " Abov Amps
Transformer/Generator INSPECTOR�s use oN�r TAL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control �
�
Swimming Pool
I hereb certi ihat I ins ted the elechical insfallation described re' on fhe dates sMted
Irrigation Boom Rough-In Dare
Speciallnsp Y� `'7`
Final . D
Irnestigative Fee �1 �
TNIS INSTALLATION MAY BE ORDERED DISCONNECTED 1F NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesl void 18 months Srom validation date printed in this box.
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PLEASe' PRINT OR TYPE
Request D�� Rough-in inspection required$ ❑ Yes p g ❑ Ready Now Will Call
❑ No Ins ecfion Ofher Than Rou han:
(You must call fhe inspecfor when ready� Date Ready:
I, (ice�sed ontracror ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box; or Route o.) Ci Zip Code
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Secfion No. Township Name or No. Range No. Fire No. Coun
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Occupanf Phone No.
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C kacfor License No. Master Lic. �
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or r Performin nsfaNbtion) J'� Phone No.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY